Care Home: Milestone House

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What the care home does well Milestone House provides a pleasant, and well-maintained environment for people to live in. The home is clean and there are systems in place to control the spread of cross infection. The home provides healthy, well-presented and nutritious meals. The cook makes alternative dinners if people do not like what is on the menu. Photos of meals have been taken and the cook is compiling a folder with them to help people choose what they want when planning the meals. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Some staff are longstanding and know people well. We saw that the people living in the home were having kind and discreet support from staff and they appeared happy receiving help from the staff team. Although most of the people living in the home use wheelchairs, skin care has been maintained to a high standard. This means people have not been at risk from pressure sores. What has improved since the last inspection? The communication assessments and plans for support for each person are well underway. The staff were enthusiastic about the plans for communication support that they are developing with the speech and language therapist. All the staff have attended training in moving and handling, first aid, infection control, health and safety and fire training. This means that they have up to date essential training to keep themselves and people safe and comply with the law. Some specialist training has also been given to support people with the needs that are related to their learning disability. A quality audit assessment and report have been carried out by an independent assessor to determine what the home is doing well and what improvements need to be made. A fire risk assessment has been carried out. Staff have had practice fire drills. The lounge has new curtains and the dining room has new blinds. A new deputy manager has been appointed and had been in post for two weeks on the day of the visit. What the care home could do better: It is important that the moving and handling guidelines for each person are in a place that the staff can easily refer to so that these are always followed. When people have been referred to specialists for advice this information needs to be used to support people much more quickly. We saw that some guidelines had been written by the new deputy and staff were following them. Making the communication aids, providing the staff training and carrying out the planned programmes for things like introducing objects of reference willMilestone HouseDS0000023751.V375122.R01.S.doc Version 5.2 enable the people living in the home to develop their ability to communicate with the people around them. What choices people are able to make also needs to be developed and this will coincide with the improved communication support. Person centred plans need to be developed. All the staff need person centred planning training. Some health action plans should be further developed. There should be a rolling programme of training to support staff to develop their specialist skills to meet individuals’ specialist needs and health care needs. The home has a system of quality monitoring but not all the recommendations from the last audit report have been acted on. A clear development plan needs to be written to incorporate all areas identified that need improvement and development. This would also assist in the direction and communication between the staff team. The deputy manager had started to compile this on the day of the visit. The home must have an evacuation plan for staff to follow in the event of an emergency. The deputy manager agreed to include all these areas in a development plan for the home. Key inspection report CARE HOME ADULTS 18-65 Milestone House 188 London Road Deal Kent CT14 9PW Lead Inspector Julie Sumner Unannounced Inspection 22nd April 2009 10:15 Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milestone House Address 188 London Road Deal Kent CT14 9PW 01304 381776 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) milestonehouse@aol.com Mr Nicholas Martine Mr Nicholas Martine Care Home 13 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) The maximum number of service users to be accommodated is 13. 2. Date of last inspection 23rd April 2008 Brief Description of the Service: Milestone House is registered to provide 24-hour residential care for up to 13 adults with learning difficulties/physical disabilities. At present there are 6 people living at the home. The home is located in a quiet residential area of the coastal town of Deal. There are public amenities and good transport links close by. The house is a large detached listed building set back from the main road in a two-thirds of an acre of grounds. There is a large, secure car parking area to the front of the house. The accommodation is arranged over two floors and there are 12 ensuite bedrooms 10 of these being on the ground floor and purpose built in 1999. The communal space includes a large lounge, dining room, a conservatory and quiet room. At the rear of the property there is a large secure garden, which is well maintained. Mr Nicholas Martine is the owner and the Registered Manager of Milestone House. The current fees for the service range from £1100 to £1730 per week For more information about the fees and services please contact the Provider. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We visited the home without telling anyone we were coming so that we could get an idea of what the usual day is like for people living in the home. We were in the home from late morning until about 8 o’clock in the evening. An ‘expert by experience’ and their personal assistant also visited the home to assist us with the inspection visit and they were in the home at the same time and left just after 1 o’clock. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We were introduced to the people living in the home and the staff. We walked round parts of the home and had a look around. We talked to some of the staff. We used the home’s AQAA (Annual Quality Assurance Assessment), that tells us what the home have improved on, what they aim to do, and lets us know when they completed important environmental safety checks. We spent some of the afternoon sitting with some of the people who live in the home. We also talked to the staff in the afternoon. In the evening we talked to the new deputy manager and looked at some more records. We looked at various records and plans kept in the home and saw part of the lunchtime medication round. We received some surveys from visiting professionals and staff. We looked at these and used the comments to help with our inspection of the home and writing the report. What the service does well: Milestone House provides a pleasant, and well-maintained environment for people to live in. The home is clean and there are systems in place to control the spread of cross infection. The home provides healthy, well-presented and nutritious meals. The cook makes alternative dinners if people do not like what is on the menu. Photos of meals have been taken and the cook is compiling a folder with them to help people choose what they want when planning the meals. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 6 Some staff are longstanding and know people well. We saw that the people living in the home were having kind and discreet support from staff and they appeared happy receiving help from the staff team. Although most of the people living in the home use wheelchairs, skin care has been maintained to a high standard. This means people have not been at risk from pressure sores. What has improved since the last inspection? What they could do better: It is important that the moving and handling guidelines for each person are in a place that the staff can easily refer to so that these are always followed. When people have been referred to specialists for advice this information needs to be used to support people much more quickly. We saw that some guidelines had been written by the new deputy and staff were following them. Making the communication aids, providing the staff training and carrying out the planned programmes for things like introducing objects of reference will Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 7 enable the people living in the home to develop their ability to communicate with the people around them. What choices people are able to make also needs to be developed and this will coincide with the improved communication support. Person centred plans need to be developed. All the staff need person centred planning training. Some health action plans should be further developed. There should be a rolling programme of training to support staff to develop their specialist skills to meet individuals’ specialist needs and health care needs. The home has a system of quality monitoring but not all the recommendations from the last audit report have been acted on. A clear development plan needs to be written to incorporate all areas identified that need improvement and development. This would also assist in the direction and communication between the staff team. The deputy manager had started to compile this on the day of the visit. The home must have an evacuation plan for staff to follow in the event of an emergency. The deputy manager agreed to include all these areas in a development plan for the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make a choice to move into the home by their representative but the information is not provided in a way that they can make use of. EVIDENCE: The statement of purpose was last updated in August 2007 and needs some updated information included as there have been some changes to the service since then. The document does not contain all the information required and therefore this also needs to be included as part of the review. There is a service user guide with some symbols. The people currently living in Milestone House cannot read so the current version is unlikely to have been helpful. The home needs to design a different service user guide. The deputy manager said that he is looking at this and will include it on the development plan for the home. We looked at the assessment information in three of the care plans. Each person has an assessment by the care manager or learning disability team. The homes assessment follows on from this and forms the basis of the care Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 10 plan. We saw an assessment by the local learning disability team carried out before a person moved in that said what the person needed. When the person moved in, the registered manager had begun an assessment to say what the person needed and how they were going to meet their needs but this was incomplete. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home would benefit from being supported further to communicate their wishes and be involved in how they are supported through person centred planning. EVIDENCE: Nearly all the people who live in the home are unable to speak to tell the staff what they want. We talked to the staff about supporting people to communicate and to make choices. Staff said they got to know people well and interpreted their facial expressions and body language. All the people in the home have been referred to the speech and language therapist and assessments have begun. We spent some time with some of the people in the home. We used our communication aid to help with our conversations. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 12 The speech and language therapist (SaLT) visited during the afternoon and we were able to have a conversation with her and the staff about the plans to develop communication support for the people in the home. The speech and language therapist is introducing the DisDAT, which is a disability distress assessment tool to interpret what people with severely limited communication are trying to say. She is working with the registered manager and teaching staff how to use the tool. The registered manager stated in the AQAA that when the DisDAT assessment has been completed they may be able to see more clearly the responses of the service users in a formal manner rather than depend on intuitive guesses. The speech and language therapist is also introducing a programme for Makaton to be used. Makaton is a system of signs that are used together with speech to help a person to understand what is being said. It also helps them to be understood if they are unable to speak or it is unclear. One of the staff said that one of the people in the home knows some signs. The staff will attend Makaton training with the aim to make this a signing home. This will speed up learning, so that when people know how to sign they will be encouraged and others will start to learn the signs. Communication passports are also being designed. Two have been started and are each very different to suit the needs of the individual. The staff talked very enthusiastically about this and one of the people who has been choosing the materials and contents of hers laughed when everyone was talking about it. We saw that staff offered people some choices during the day. This included asking different people at different times if they would like a drink, to go to the toilet, if they would like a shower and a bath. Staff were unsure what to do if people refused something offered that they needed like the toilet or a bath. The plans need to include guidelines for this. Each person has a detailed care plan in an individual folder. We looked at two plans in detail and two more generally. Risk assessments and guidelines are included in the care plans. We also looked at the daily reports written by staff. They contain basic facts about care given. We found it difficult to find information in the plan because they were so big. The staff said they did not find them very easy to use as well. Earlier in the day staff had said that they learn from each other and as they go along. We spoke to the deputy manager about making the plans user friendly and about person centred planning. The deputy manager was aware that the plans need to be improved upon to make them working documents. This is included in his own development plan for the home. We agreed that person centred planning training for the staff would support this. During the visit we saw that staff do not always respect the privacy and dignity of the people living in the home. We saw an unused incontinence pad left on a Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 13 table during breakfast. We saw that staff do not always knock before entering people’s bedrooms. We saw personal information about people in a communal record for staff. All personal information needs to be kept confidentially and any communal records must only refer to individuals and where to look for relevant information. The deputy manager said he would talk to the staff about these issues. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are provided with some activities but would benefit from getting out in the community more. People would also benefit from being more involved in the day to day running of the home like meal preparation and for activities to be meaningful to them and develop their life skills. EVIDENCE: Staff showed us the activity timetables in the care plans. People go out with the staff on the minibus for activities like shopping, to the pub, discos, out for meals and swimming. They said this is only a guide, people do not always participate in everything. What people like to do is written in their care plan. We saw that one person really likes water activities and particularly likes going swimming. We looked at the records and found that these activities are Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 15 offered rarely with swimming only being offered once during the last month. It also states in one persons plan that they need to go for regular walks about three times a week but most weeks they have only gone out for a walk once. We saw that most of the time staff offer an activity and individuals can agree to do this or not. The activities coordinator said she is planning to make larger picture activity timetables. At present there are small planners in the bedrooms. People were doing different things at different times during the visit. Some of the activities we saw were card making, listening to music, foot massage, going out to buy a magazine and someone relaxing in the sensory room. We saw that people were enjoying the activities offered. None of the activities currently provided are working towards anything like a skill development. We asked if people go on holiday. The staff said that no one has been on holiday and that they planning special days out. One of the people has expressed a wish to go on holiday to Butlins. Looking at ways to support a holiday break needs to be included in the development plan. People are supported to stay in touch with their families. Who is important to people is written in their care plan. Relatives and friends can visit the people living in the home. Some of the people go to stay with their families regularly. We saw that the people living in the home have a choice of when to go to bed. People are supported flexibly. Some people were in the dining room having breakfast in their night clothes. This shows that they do not all have to get dressed first. The cook explained about the mealtimes. We saw that they are relaxed and people are supported individually. Choices are given by showing people the meal served up. The cook is developing a photo menu folder so that people can choose from this. One of the people living in the house looked at it with us when we were talking about the meals and pointed to some of the photos. The cook will make an alternative if someone does not want to eat what is offered. At present no one who lives in the home goes into the kitchen because the layout is not suitable for wheelchairs. The kitchen is reasonably spacious and some of the furniture is movable so it can be reorganised. The cook does carry out some meal preparation sessions in the dining room, like cake making, where the people living in the home can participate in part of the activity. People need to be given the opportunity to participate in ordinary cooking and mealtime activities as part of their day to day routine. The cook agreed that the participation could be expanded but is going on maternity leave so this also needs to be included in the development plan. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported well with their personal care. There are some interventions with health care needed, but people are waiting for the outcomes of referrals from specialists before their needs can be met fully. Medication practice is safe protecting the people living in the home. EVIDENCE: The AQAA did not tell us very much about how people are supported with their health and personal care. We spoke to the deputy manager about this so that there is more information included in the next AQAA given to us. Staff talked about how they support the people living in the home. They explained how they protect people’s skin by making sure they move position and are kept clean and dry. We saw that people looked well and clean and were dressed nicely. Staff said they have got to know each person well so that they can find out how they like to be supported with their personal care. There is a general routine for providing personal care in the home. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 17 Each person has a GP, who has been chosen on his or her behalf. The people living in the home have the support of health care professionals visiting the home, including the local learning disability team. There were some records in people’s care plans about visits from the occupational therapist, health care appointments and referrals to specialists. Each person has been referred to the speech and language therapist. Two people have been referred to a consultant. One of the staff explained that one of the people living in the home needs some medical investigations and it is necessary to have a best interests meeting, as they are unable to consent to the treatment themselves. There is a health action plan tool in the care plan. At the inspection visit last year staff were completing these and some were more complete than others. In the three care plan files that we looked at two health action plans had not yet been started. However, the focus is on developing the communication tools in the home so the health action plans will form part of this process. The deputy manager said that this is going to be included in his development plan for the home. Some of the people living in the home have medical conditions, like epilepsy, that are monitored by the GP and specialists. We saw some records in the care plans. Some of the staff have had training in epilepsy awareness. The deputy manager is aware that all the care staff need to have this training to make sure that people’s needs are being met. A variety of specialist equipment is provided to support each person. These include specialist beds, hoists and chairs. The people who live in the home have their medication given to them by the staff. Medication is administered via a monitored dosage system. We looked at the medication storage and administration records. We found that handwritten prescription items added to the recording sheet had only been signed by one person. It is good practice for two people to sign to double check for errors. Other records had been written clearly. Staff have attended the basic medication training so that they know how to use the system. Some staff have also attended training which gives more detail about the types of medication. We asked if there was any information about the medication prescribed. There is a list of medication in each person’s care plan folder but no explanation of why they are prescribed this and what side effects staff should look out for. The deputy manager said he would make this information available to staff. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people living in the home are able to complain and more assistance with communication methods is needed. There is inconsistency around how to support individuals with behaviour. EVIDENCE: Individuals need to have more developed communication support and aids so that they can make their wishes known. As stated earlier in this report the communication aids are being developed. There is a complaints procedure that can be accessed by a person’s representative. The home have received one complaint using this procedure that has now been resolved. There is a straight forward safeguarding policy and whistle blowing policy. At present if staff are concerned about something they will speak to the deputy manager or registered provider. The deputy manager explained that this is the subject of the next staff meeting, so that staff will be given the information to guide them confidently through a safeguarding alert or referral. A safeguarding investigation was conducted by the multi-agency team following an accident. This also raised concerns about moving and handling practice. We saw that there are risk assessments for moving and handling Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 19 people and nearly all staff have attended moving and handling training or it is planned for. However in conversation with staff during the visit the guidelines are not always being referred to. Staff have got to know the people living in the home very well and are supporting each other with practice by verbally relaying information. The deputy manager said that he has observed the staff’s practice and has not had any concerns. We discussed moving and handling with the deputy manager and he agreed that it is important for the guidelines to be accessible so that staff use them and there is a consistent approach. Staff have attended training in safeguarding. Staff were aware that if they suspected abuse they would report this to the senior member of staff in the home. The deputy manager showed us his plan for the next staff meeting which is to focus on safeguarding awareness and procedures to follow. Staff were not confident in managing individual’s behaviour and there were gaps in guidelines and information in the care plan for this. We saw that a small amount of money is kept in the home for buying things like magazines and is kept individually for each person. None of the people currently living in the home are able to manage their own money. They either have their family as their representative or a social services client financial affairs officer to do this. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and decorated to a good standard providing people with an attractive and homely place to live. The house is clean and hygienic. EVIDENCE: We looked around the home with the staff. The home has a large dining room and a lounge with wide doors making it accessible for wheelchair users. The home currently has two shower rooms. There are plans for the ground floor bathroom to be made bigger by knocking down a connecting wall into the second bathroom. Staff said that it would be much better to have one large bathroom as it is difficult to use the current bathrooms for people in wheelchairs. They have to have the door open and one of the bathrooms cannot be used for people who need to be hoisted because there is not enough Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 21 space. The new bathroom will also include a changing area which will offer a more convenient and dignified facility for the people living in the home. There is a conservatory which is used as a quiet room where people can go to relax or undertake activities like card making, drawing and having hand and foot massage if they wish and for one to one sessions with the staff. Peoples’ bedrooms are clean and personalised, with their own pictures and ornaments. The communal parts of the home are open and people were in the lounge, conservatory, dining room and sensory room at different times of the day. The bedrooms and the bathrooms in the home have latches on to stop one person’s entrance, for assessed reasons. This does not negatively impact on other people’s use of the home, but the individual person in question should be supported with a Depravation of Liberty assessment as a review of support being given. The bedrooms were locked but no one currently living in the home has a key. We spoke to the deputy manager about reviewing the need to lock the doors in the home and to consider other ways to safeguard the people living there without restricting access. There is a large tidy and accessible garden to the rear of the building. The home employs a cleaner who works flexible hours. We saw that the home is well maintained and clean. There is a laundry in the basement which means it is not accessible to the people living in the home. It has all the facilities needed to wash soiled and infected linen. The home has 2 washing machines with sluicing facilities. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have confidence in the staff. Current staff levels mean that it is difficult for people to go out and about frequently and for people to be supported with their care needs too, which limits community recreational activities. The deputy manager is aware that there are some gaps in training and plans to deal with this. EVIDENCE: We talked to the deputy manager about the staffing in the home. We looked at five staff files. We discussed the current staffing level. There are usually 4 care staff during the day including the activities coordinator and 3 staff in the evening. The activities coordinator does not carry out caring duties and does not go out with people. Nearly all the people living in the home need to be supported by two people for their care and when going out. This means that with the current level of staff, it is difficult for people to go out and for people to be supported with their care needs as well. We received some surveys from staff. They contained mostly positive comments. When asked what could Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 23 better there were comments about staff training and more staff so that they could take people out more. The home has a clear recruitment procedure and safety checks are carried out to make sure staff are suitable to work with vulnerable adults. The staff that we spoke to and whose files we looked at had only had the homes basic induction training. The registered manager had said he had got induction training packs based on the skills for care common induction standards at the last inspection visit but we did not see this in use. The deputy manager showed us the learning disability induction pack that he is planning to introduce and this does meet all the standards. Staff supervision is starting to happen more regularly. Since the deputy manager has been in post he has held one-to-one supervision meetings with each member of the day staff and has booked meetings with the night staff. All the staff now have up to date training that is required by law for health and safety. There are some gaps with training to support the people in the home with their specific needs like their behaviour and health needs. We spoke to the deputy manager about staff training. He had identified some gaps in the staff training prior to the inspection visit and is developing the training plan for the home. We spoke to staff about their training. Some of the staff have achieved the national vocational qualification and some are studying it. This will cover some of the skills they need. Staff spoken to were enthusiastic about the planned training by the speech and language therapist. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified and has relevant experience to run the home. He is aware of the areas that need improvement and has plans to do this. EVIDENCE: The registered manager has owned and run the home for nearly 20 years. He has recently employed a deputy manager. The registered manager was not at the home on the day of the visit. The deputy manager assisted us with the visit. The registered manager employed the services of a consultant to carry out a quality audit in June 2008. We looked at the report. The registered manager Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 25 has requested that the deputy manager look at outstanding issues from the previous inspection and the homes quality monitoring audit and devise a development plan. The deputy manager has made a good start on this. The registered manager said in the AQAA that they regularly communicate with families and surveys are sent out every year. The deputy manager has looked at recent surveys as part of his planning. The registered manager said they obtain the views of the people living in the home by holding a client forum every 3 months. The staff said these are held but they do not have any minutes. On the day of the visit the client forum meeting had been arranged by the deputy manager. He asked one of the staff to chair it as he was interviewing new kitchen staff to cover the cooks maternity leave. The staff held the meeting but were not confident. Some of the people clearly responded to the meeting and it is worthwhile but requires better planning and more time to be effective. All the staff now have up to date training that is required by law for health and safety. The deputy manager is observing the staff when they are working at different times of the day to make sure they are working safely. The deputy manager is also checking the homes policies so that they reflect working practice. He is also checking the guidelines in the individual care plans to make sure staff are able to follow them too. The AQAA did not indicate that any of the homes policies had been reviewed and updated. The deputy manager said that he has looked at the policies and seem relevant. He said he would update them. The home is well maintained and regular servicing is carried out. The dates of the most recent services were included in the AQAA. This outcome area has been judged as adequate because although improvements have been made to the systems, the action identified has not yet fully been carried out. Progress has been made on the requirements from the last inspection but not all have been fully met and some are long standing. For this reason a code B notice was served on the day of the visit. This tells the person in charge of the home that we feel that an offence under the Care Standards Act 2000 may have been committed, and the notice tells the person in charge their rights. The registered provider needs to make sure that improvements are made to the service and that all requirements are fully met or we may take enforcement action. Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x 2 2 x 2 x Version 5.2 Page 27 Milestone House DS0000023751.V375122.R01.S.doc yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 12, 13 Requirement Where systems of communication and choice making already exist from speech and language assessment, these must be used to aid each individual persons’ opportunities. To ensure that staff have the skills to support people they must have training related to people’s specific needs: Epilepsy awareness Learning disabilities Communication skills Person centred planning Managing challenging behaviour To ensure that people are moved and handled safely, they must have clear, thorough guidelines in place for staff to follow. Timescale for action 30/06/09 2. YA32 18 31/07/09 3. YA42 YA6 YA9 13 30/06/09 Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Milestone House DS0000023751.V375122.R01.S.doc Version 5.2 Page 29 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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